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itake

> Perhaps the government should simply pay people to keep their BMI under 25.

The problem is we are doing the opposite: We pay people (subsidize) their unhealthy food (corn, sugar, and beef).

We should just make healthy food cheaper.

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We also outlaw health plans providing discounts to those who lead healthy lifestyles.

We also have car centric city planning, which is going to take untold amounts of time and capital to shift away from.

https://www.flickr.com/photos/carltonreid/4646637491

Good thing then that exercise (while healthy in other ways) burns relatively few calories.

We have had a car culture for far longer than we have had an obesity problem

Cars are not the reason this nation is getting fatter

Right. The argument for why they're bad is straightforward, but the rankings don't line up. [1] [2]

[1] https://en.wikipedia.org/wiki/List_of_countries_by_vehicles_...

[2] https://en.wikipedia.org/wiki/List_of_countries_by_obesity_r...

Miles driven per capita would be a better comparison. Americans drive more than any other country.

https://www.thecarcrashdetective.com/americans-drive-more-dy...

You'd want to measure butt in seat hours since the problem isn't the distance but being sedentary.

OK, but they cause a lot of death and injury quite apart from their effect on weight. Societies that drive more miles have higher mortality rates. When you compare health care in the U.S. to other Western countries you have to consider how much we drive, how fat we are, and how many of us overdose.

This is a topic about obesity not how cars do not do not contribute to other health concerns.

This subthread was actually about the feasibility of public health programs in the U.S. And that's a topic that needs to account for those 3 areas in which we are outliers, especially if, as inevitably happens, people get around to drawing comparisons between the U.S. and Europe.

This is like saying we’ve had the Internet a lot longer than we’ve had social media addiction.

Obesity rates started rising with the introduction of drive-in food, which wouldn’t exist if it wasn’t for car culture.

Well if I have to choose between Car Culture, Fast Food food, and Obesity, or giving up those things.

I choose FAT... every day.

Thankfully that is a False dilemma, and we can keep our car culture and rollback obesity at the same time

Most of the people focusing on "car culture" do not really care about obesity, it is a proxy war for Climate Change, and opposition to Rural America.

I will never accept high population density, and electric cars will resolve the climate change issue

This is probably sensible.

The current article suggests obesity is the top modifiable dementia risk, which suggests that there's other risk factors that are more important and not modifiable.

It might be tricky to actually reward healthy lifestyles via health plans, since people generally need more care as they get older.

The people farming the healthy food are not a big enough voting bloc for this to happen.

But it's not the kinds of food you eat that make you fat. It's how much food you eat. Remember the Twinkie diet?

What you eat and how much you eat don’t seem to be strictly independent from each other, especially when applied over long periods.

There's more to being healthy than being not fat.

Sure, but this article is about obesity in particular.

Is there? Because the evidence for weight loss to improve health is consistent, abundant, and overwhelming. And the evidence for all the other stuff seems to reside mostly in the realm of unverified "common sense."

Weight is a proxy for all sorts of related diet issues. You can lose weight on a Twinkie diet and not be metabolically healthy at the same time.

A healthy diet requires more than just the appropriate caloric intake. Although that’s a great starting point.

I'm not saying people should actually follow the Twinkie diet because they want to lose weight, just that a handful of people have done it as an example to prove it's only CICO that matters. Besides, anyone with the discipline to follow the Twinkie diet could easily follow a healthier diet too.

metabolically, puh, what's that even mean?

“Clinically speaking, metabolic health is defined by optimal levels of five markers: blood sugar, triglycerides, high-density lipoprotein (HDL) cholesterol, blood pressure, and waist circumference—without using medication.“

Things like a high sugar Twinkie diet will expose you to diabetes risk independent of calorie intake.

I was being sarcastic — but genuinely thank you.

You don't eat only for energy, you also eat for nutrients - and they are a lot more varied and complex than the standard list of protein, carbs, fat, vitamins.

To use an extreme example so that it's easier to relate to: You can eat only sugar and nothing else and far exceed your energy requirements, but you will still have lots of appetite despite already having eaten too much in just energy.

Food composition matters - and optimizing for energy (counting calories) is a losing battle. Of course, this also requires that people have had experience with various foods. Kids grown on mostly just fast food, pizza and coke probably won't be able to develop healthy habits no matter what.

Yes it is technically possible to force a body to remain slim by counting calories. It also is either very cruel or, if you manage it on your own, requires an absurd amount of discipline to constantly battle your desires. Yes some people have a huge appetite for the obviously wrong kinds of foods, like more pizza and more ice cream and no water please because it "does not have taste" but coke or some other industry-made drink. When the body was "mis-trained" it can't magically desire the right stuff that it never learned about. The environment matters too, it's probably a lot easier to not eat terribly in Japan than in some US mid-west town.

I know eating healthy food for non-caloric nutrients is important. But don't most people already eat at least some healthy food? Couldn't most obese people get back to a healthy weight just by cutting out junk food, without adding any more healthy food to replace it?

They're usually poor and the junk food is subsidized. The us has underground cheese bunkers to keep the dairy industry running, you won't be seeing a nutritionally complete tempeh salad on the dollar menu.

Is there literally any straightforward evidence that diet composition affects mortality?

> affects mortality?

Why would you only care about mortality?

I had some unfortunate experience with heavy metal poisoning (university clinic diagnosed - mercury, shown by lab tests). There was zero danger of dying and I doubt it took away any of my life expectancy. But it SUCKS and especially the brain works at a substantially lower level. I did not understand even simple sentences even after reading them several times at the height of the problem. I wrote Internet comments that made no sense when I read them again the next day, but at the time it felt perfectly alright and logical (sentence structure was weird too).

(Just an aside) And you know what? I had to end up with a senior researcher doctor at a university clinic before getting diagnosed. Because most doctors were a little like your question: They looked at the vitals and found no obvious disease and sent me home "it's all in your head". Which is funny because it's largely true - mercury being a neurotoxin, but for some reason the brain being the product of physics and bio-chemistry not registering with the oh so "science and evidence" based doctors, who seem to have a strangely meta-physical and esoteric view of it.

Anyway, back on topic:

I find this obsession with the binary outcome "death / no death" strange. Before death, your extremely parallel structure (not just your own trillions cells, each cell itself has lots of independently working parts, and then there are even more bacteria and other organisms occupying your insides and the outside who all contribute and are often affected too) does a poorer job of bringing the "you" into being. See your body like a computer running the software that is "you". The quality of the simulation drops if the hardware is impacted (you are the activity of your parts - a brain without activity is not "you", you are not there if the hardware does not run the "you" software). But the life expectancy may not be impacted at all.

Surely, if you provide far from optimal fuel you can expect the quality to suffer too, not just when you are poisoned or otherwise restricted.

So, it is a question of what version of "you" do you want to be? Is mere existence enough?

It's not that I object to any of that, so much as it's just that mortality is a lot easier to measure.

These subsidized 'unhealthy' foods are highly calorie dense. While in-theory, you can eat less, you will not feel full like you would with low calorie dense food.

For example, an Apple weights 200g and is 110 calories. Whereas a double cheeseburger at McDonald's is 173 grams but 450 calories.

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